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Annals of Oncology Advance Access originally published online on November 2, 2005
Annals of Oncology 2006 17(2):217-225; doi:10.1093/annonc/mdj048
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© 2005 European Society for Medical Oncology

Comparing cost/utility of giving an aromatase inhibitor as monotherapy for 5 years versus sequential administration following 2–3 or 5 years of tamoxifen as adjuvant treatment for postmenopausal breast cancer

P. E. Lønning*

Section of Oncology, Institute of Medicine, University of Bergen, Haukeland University Hospital, Bergen, Norway

* Correspondence to: Dr P. E. Lønning, Section of Oncology, Institute of Medicine, University of Bergen, Haukeland University Hospital, N-5021, Bergen, Norway. Tel: +47-55-972027; Fax: +47-55-973599; E-mail: per.lonning{at}helse-bergen.no

Background: Several studies have shown aromatase inhibitors administered as monotherapy or sequentially to tamoxifen to improve relapse-free survival in postmenopausal women with early breast cancer. Any difference in cost/utility between the strategies may be of importance to therapy selection.

Methods: Cost/utility was compared between the different regimens based on the theoretical assumption that costs, benefits and side-effects were similar for each drug and independent of whether it was administered as monotherapy or sequentially.

Results: Tamoxifen for 2–3 years followed by an aromatase inhibitor for 3 or 2 years provided the lowest cost/quality-adjusted life years (QALY) estimates, while administration of an aromatase inhibitor subsequent to 5 years on tamoxifen provided the highest values. The difference between strategies increased with patient age. Cost/QALY estimates were sensitive to an increase in hip fracture risk and to cost reductions due to relapse prevention. Adding oral bisphosphonates increased costs moderately.

Conclusions: While tamoxifen for 2–3 years followed by an aromatase inhibitor provided the lowest cost/QALY estimates, a further improvement of relapse-free survival of 1% if the aromatase inhibitor is given upfront provides an acceptable cost/QALY. In contrast, additional benefits achieved by administering an aromatase inhibitor subsequent to 5 years of tamoxifen provided unacceptable costs.

Key words: adjuvant therapy, aromatase inhibition, breast cancer, costs, utility


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This article has been cited by other articles:


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Reply to 'Conclusions regarding relative cost-utility of alternative strategies for use of aromatase inhibitors in postmenopausal women with early breast cancer are premature' by Delea et al.
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[Full Text] [PDF]

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Conclusions regarding relative cost-utility of alternative strategies for use of aromatase inhibitors in postmenopausal women with early breast cancer are premature
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